title: Risk stratification in patients with acute chest pain using three high-sensitivity cardiac troponin assays.
abstract: OBJECTIVE
  Several high-sensitivity cardiac troponin (hs-cTn) assays have recently been developed. It is unknown which hs-cTn provides the most accurate prognostic information and to what extent early changes in hs-cTn predict mortality.
  
  
  RESULTS
  In a prospective, international multicentre study, cTn was simultaneously measured with three novel [high-sensitivity cardiac Troponin T (hs-cTnT), Roche Diagnostics; hs-cTnI, Beckman-Coulter; hs-cTnI, Siemens] and a conventional assay (cTnT, Roche Diagnostics) in a blinded fashion in 1117 unselected patients with acute chest pain. Patients were followed up 2 years regarding mortality. Eighty-two (7.3%) patients died during the follow-up. The 2-year prognostic accuracy of hs-cTn was most accurate for hs-cTnT [area under the receivers operating characteristic curve (AUC) 0.78 (95% CI: 0.73-0.83) and outperformed both hs-cTnI (Beckman-Coulter, 0.71 (95% CI: 0.65-0.77; P = 0.001 for comparison), hs-cTnI (Siemens) 0.70 (95% CI: 0.64-0.76; P < 0.001 for comparison)] and cTnT 0.67 (95% CI: 0.61-0.74; P < 0.001 for comparison). Absolute changes of hs-cTnT were more accurate than relative changes in predicting mortality, but inferior to presentation values of hs-cTnT. Combining changes of hs-cTnT within the first 6 h with their presentation values did not further improve prognostic accuracy. Similar results were obtained for both hs-cTnI assays regarding the incremental value of changes. Hs-cTn concentrations remained predictors of death in clinically challenging subgroups such as patients with pre-existing coronary artery disease, impaired renal function, and patients older than 75 years.
  
  
  CONCLUSIONS
  High-sensitivity cardiac Troponin T is more accurate than hs-cTnI in the prediction of long-term mortality. Changes of hs-cTn do not seem to further improve risk stratification beyond initial presentation values.
authors.affiliation: Department of Cardiology, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland.
authors.forename: Philip
authors.initials: P
authors.lastname: Haaf
authors.forename: Tobias
authors.initials: T
authors.lastname: Reichlin
authors.forename: Raphael
authors.initials: R
authors.lastname: Twerenbold
authors.forename: Rebeca
authors.initials: R
authors.lastname: Hoeller
authors.forename: Maria
authors.initials: M
authors.lastname: Rubini Gimenez
authors.forename: Christa
authors.initials: C
authors.lastname: Zellweger
authors.forename: Berit
authors.initials: B
authors.lastname: Moehring
authors.forename: Catherine
authors.initials: C
authors.lastname: Fischer
authors.forename: Bernadette
authors.initials: B
authors.lastname: Meller
authors.forename: Karin
authors.initials: K
authors.lastname: Wildi
authors.forename: Michael
authors.initials: M
authors.lastname: Freese
authors.forename: Claudia
authors.initials: C
authors.lastname: Stelzig
authors.forename: Tamina
authors.initials: T
authors.lastname: Mosimann
authors.forename: Miriam
authors.initials: M
authors.lastname: Reiter
authors.forename: Mira
authors.initials: M
authors.lastname: Mueller
authors.forename: Thomas
authors.initials: T
authors.lastname: Hochgruber
authors.forename: Seoung Mann
authors.initials: SM
authors.lastname: Sou
authors.forename: Karsten
authors.initials: K
authors.lastname: Murray
authors.forename: Jan
authors.initials: J
authors.lastname: Minners
authors.forename: Heike
authors.initials: H
authors.lastname: Freidank
authors.forename: Stefan
authors.initials: S
authors.lastname: Osswald
authors.forename: Christian
authors.initials: C
authors.lastname: Mueller
mesh_terms: D000368:Aged; D000789:Angina, Unstable / Q000175:diagnosis* / Q000401:mortality; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood; D002637:Chest Pain / Q000209:etiology* / Q000401:mortality; D052279:Creatine Kinase, MB Form / Q000097:blood; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000401:mortality; D009211:Myoglobin / Q000097:blood; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods; D012680:Sensitivity and Specificity; D020107:Troponin T / Q000097:blood*
chemical_list: D015415:Biomarkers; D009211:Myoglobin; D020107:Troponin T; D052279:Creatine Kinase, MB Form
keywords: Acute chest pain; Acute myocardial infarction; High-sensitivity cardiac troponin; Risk stratification